Päivi Leikkola

Patient and Staff Safety Incidents and Near Misses in Out-Of-Hospital Emergency Care

Objectives: The purpose of this qualitative study is to describe patient and staff safety incidents and near misses in out-of-hospital emergency care with the aim of providing new knowledge that can be useful in preventing and decreasing risks in emergency care. Research Methodology and setting: The data consisted of voluntary, anonymous reports collected online from emergency care staff in 2013 in one hospital district that serves a population of 200,000 in Finland. A total of 45 incident descriptions of adverse incidents, risks and near misses were accrued, all of which were analyzed using inductive content analysis. Results: The results reveal that threats to patient safety are associated with the patient’s psychological and physical status, medication, care equipment and context. In occupational safety of emergency care providers, the patient’s mental ill-being and aggression, the context, care equipment and emergency driving constitute potential sources of risks. Conclusion: As only a limited number of incidents were reported, staff should be encouraged to use the reporting system as an essential part of quality management in emergency services. More attention needs to be paid to assessing the overall emergency situation from the viewpoint of safety and the level and reliability of information before starting diagnostic procedures and treatment. Education and study of earlier safety incidents can help prevent risks.

Counseling patients and family members in out-of-hospital emergency situations: a survey for emergency staff

BackgroundNot much is known about emergency care delivered in patients’ homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff’s experiences of encountering and counseling patients and their family members.MethodsA descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N = 142 reponse rate 59%) and analyzed using descriptive statistics.ResultsRespondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging.ConclusionsHigh-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient’s and family’s situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.

774 Factors that improve the safety of patient care as experienced by emergency medical care providers

Background An increasing number of acutely ill patients are not transported to hospital but treated in their homes or another location. Special attention should be paid to factors that affect patient safety (Ministry of Social Affairs and Health 2014.) Methods The study describes factors that promote the safety of patient care in out-of-hospital emergency medical care, as experienced by care providers. The data were collected by semi-structured interviews (n = 15) with care providers selected by discretionary sampling. The material was analysed using inductive content analysis. Results Patient safety improves with successful consultation with the emergency physician and with holistic consideration of all factors that affect the patient’s coping. Safety is further promoted by the emergency care provider’s theoretical, practical and attitudinal competencies and co-operation skills. Situational sensitivity is an important factor intertwined with the care provider’s personality, emotional intelligence and discretion. Moreover, safety can be improved by making certain that individual procedures are carried out safely and by ensuring continuity of care and coping with home care. Finally, management practices that aim at workers’ wellbeing at work increase patient safety. Conclusions A study of factors that improve or impair patient safety can help care providers anticipate threats and prevent risks.

Factors that Influence the Counselling of Family Members in Out-of-HospitalEmergency Medical Care

Background: Counselling family members of acutely ill patients has not been studied from the perspective of out-of-hospital emergency care. The purpose of this study was to fill the research gap by describing care providers’ experiences of factors that influence counselling and supporting family members in out-of-hospital emergency care. Methods: The data were collected by semi-structured interviews of emergency care providers (N=15) in Finland in 2014 and analysed using content analysis. Results: Factors that influence the counselling aimed at family members in out-of-hospital emergency care can depend on the patient, family member, emergency care provider or context. Patient-dependent factors involve the patient’s personality, severity of physical and psychological symptoms, criticality of the situation, the patient’s memory, responses, behaviour and cognitive abilities and emotional resources. Family member-dependent factors include the family members’ needs and responses, fears, anxiety, feelings of not having control, needs for support, cognitive and emotional preparedness to commit themselves to help and support the patient and willingness to engage in supporting the patient. Care provider-dependent factors include the care provider’s personality, clinical expertise, theoretical and practical competence, work and life experience and attitudes. Context-dependent factors include time, degree of urgency, safety of the environment and the circumstances. Conclusions: Care providers must gain an overall idea of the family’s function and their ability to endure stress in acute situations, so that counselling can be founded on the family’s strengths and limitations regarding the patient’s follow-up care and coping at home. Ability to differentiate between various factors in counselling situations helps care providers concentrate on factors that they can affect. The results can be used in the education of health carestudents and professionals and in developing the quality of counselling.